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Chuang LH, Zhang H, Hong T, Xie S. Evaluating the Preferences and Willingness-to-Pay for Oral Antidiabetic Drugs Among Patients with Type 2 Diabetes Mellitus in China: A Discrete Choice Experiment. THE PATIENT 2024; 17:565-574. [PMID: 38642244 DOI: 10.1007/s40271-024-00694-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE To quantify the preferences for an oral antidiabetic drug (OAD) among patients with type 2 diabetes mellitus (T2DM) in China. METHODS A discrete choice experiment (DCE) with hypothetical OAD profiles was performed among patients with T2DM recruited from both online and offline sources. Each patient completed 12 DCE choice tasks. The attributes, elicited through mixed methods, include blood glucose level decrease, blood glucose level stability, frequency of medication, gastrointestinal side effects, dose adjustment and out-of-pocket expense. The conditional logit regression model was used to analyze the data. Patients' willingness-to-pay (WTP) was also calculated. Subgroup analyses based on patient characteristics were also conducted. RESULTS A total of 741 respondents were included in the analysis sample, covering 456 respondents online and 285 offline. The result showed that all attributes and levels were statistically significant, except one level "dose adjustment required for patients with hepatic or renal insufficiency" in the attribute of dose adjustment. WTP results showed that patients were willing to pay 12.06 and 23.20 yuan, respectively to reduce the frequency of medication from "once per day" and "three times per day" to "once every 2 weeks", respectively. Subgroup analyses showed that the frequency of medication (once versus two to three times per day) had the largest impact and influenced most coefficient estimates. CONCLUSION The results suggest that Chinese patients with T2DM prioritized better efficacy, less frequency of medication, lower gastrointestinal side effects, no dose adjustment required for patients with hepatic or renal insufficiency, and less out-of-pocket expense of OAD treatment.
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Affiliation(s)
- Ling-Hsiang Chuang
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- GongJing Healthcare (Nanjing) Co. Ltd, Nanjing, China
| | - Huanlan Zhang
- GongJing Healthcare (Nanjing) Co. Ltd, Nanjing, China
| | - Tianqi Hong
- School of Biomedical Engineering, McMaster University, Hamilton, Canada
| | - Shitong Xie
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
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Bohorquez NG, Malatzky C, McPhail SM, Mitchell R, Lim MHA, Kularatna S. Attribute Development in Health-Related Discrete Choice Experiments: A Systematic Review of Qualitative Methods and Techniques to Inform Quantitative Instruments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02401-X. [PMID: 38851483 DOI: 10.1016/j.jval.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 05/14/2024] [Accepted: 05/24/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVES This review sought to identify the qualitative methods and techniques that researchers have used in the past decade to develop attributes and inform health-related discrete choice experiments (DCEs) surveys from a patient perspective. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting systematic reviews. An adapted appraisal tool following guidelines for reporting qualitative research for quantitative instruments and criteria for attribute development in DCEs was applied for quality assessment and data extraction. A narrative approach was used to synthesize data. This examination included consideration of issues pertaining to sampling, data collection, data analysis, attribute list reduction, wording, methodological adaptations to capture patient preferences, and testing the pre-experimental design decisions of the DCE survey. RESULTS Of 8505 articles identified for abstract screening, 680 were included for full-text screening, 36 of which met the inclusion criteria. Practices to improve methodological robustness included pre-data collection materials to inform instruments, data collection methods specific for decision-making scenarios, purposeful selection of data analysis methods to address the research question, and participants' involvement in reducing the list of attributes. Examples of methodological adaptations for patients were noted. CONCLUSIONS DCEs have the potential to become a mixed-method approach in which the qualitative phase informs a reduced list of attributes for a survey, serves the predesign decisions of the experiment by testing trade-offs, overlapping, understandability, face, and content validity and provides explanations of the quantitative results. Establishing guidelines for using qualitative methods for DCE attribute development may help to broadly enhance the methodological robustness of DCEs.
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Affiliation(s)
- Natalia Gonzalez Bohorquez
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Christina Malatzky
- Centre for Justice and Centre for Decent Work and Industry, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Remai Mitchell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Megumi Hui Ai Lim
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
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Quinlan-Davidson M, Dixon M, Chinnery G, Hawke LD, Iyer S, Moxness K, Prebeg M, Thabane L, Henderson JL. Youth not engaged in education, employment, or training: a discrete choice experiment of service preferences in Canada. BMC Public Health 2024; 24:1402. [PMID: 38797845 PMCID: PMC11129463 DOI: 10.1186/s12889-024-18877-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/17/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Prior research has showed the importance of providing integrated support services to prevent and reduce youth not in education, employment, or training (NEET) related challenges. There is limited evidence on NEET youth's perspectives and preferences for employment, education, and training services. The objective of this study was to identify employment, education and training service preferences of NEET youth. We acknowledge the deficit-based lens associated with the term NEET and use 'upcoming youth' to refer to this population group. METHODS Canadian youth (14-29 years) who reported Upcoming status or at-risk of Upcoming status were recruited to the study. We used a discrete choice experiment (DCE) survey, which included ten attributes with three levels each indicating service characteristics. Sawtooth software was used to design and administer the DCE. Participants also provided demographic information and completed the Global Appraisal of Individual Needs-Short Screener. We analyzed the data using hierarchical Bayesian methods to determine service attribute importance and latent class analyses to identify groups of participants with similar service preferences. RESULTS A total of n=503 youth participated in the study. 51% of participants were 24-29 years of age; 18.7% identified as having Upcoming status; 41.1% were from rural areas; and 36.0% of youth stated that they met basic needs with a little left. Participants strongly preferred services that promoted life skills, mentorship, basic income, and securing a work or educational placement. Three latent classes were identified and included: (i) job and educational services (38.9%), or services that include career counseling and securing a work or educational placement; (ii) mental health and wellness services (34.9%), or services that offer support for mental health and wellness in the workplace and free mental health and substance use services; and (iii) holistic skills building services (26.1%), or services that endorsed skills for school and job success, and life skills. CONCLUSIONS This study identified employment, education, and training service preferences among Upcoming youth. The findings indicate a need to create a service model that supports holistic skills building, mental health and wellness, and long-term school and job opportunities.
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Affiliation(s)
- Meaghen Quinlan-Davidson
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mahalia Dixon
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | | | - Lisa D Hawke
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Srividya Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Centre, Montreal, QC, Canada
| | | | - Matthew Prebeg
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - J L Henderson
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Donnan J, Johnston K, Coombs M, Najafizada M, Bishop L. Exploring consumer preferences for cannabis edible products to support public health policy: A discrete choice experiment. PLoS One 2024; 19:e0292336. [PMID: 38753807 PMCID: PMC11098505 DOI: 10.1371/journal.pone.0292336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/22/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND In October 2019, cannabis edibles were legalized for sale in Canada for non-medical use. This move was intended to improve public safety by regulating contents (including a maximum 10 mg tetrahydrocannabinol (THC) per package) and packaging to prevent accidental ingestion or over consumption. This study aimed to explore consumer preferences for cannabis edibles to inform cannabis policy. METHODS We explored the relative importance and trade-offs consumers make for attributes of cannabis edibles using a discrete choice experiment. Attributes included type of edible, price, THC content, cannabis taste, package information, product consistency, product recommendations, and Health Canada regulation. Participants lived in Canada, were 19 years of age or older, and purchased a cannabis edible in the last 12 months. A multinomial logit (MNL) model was used for the base model, and latent class analysis to assess preference sub-groups. This study was approved by the institutional ethics committee. RESULTS Among 684 participants, the MNL model showed that potency was the most relevant attribute, followed by edible type. A two-group latent class model revealed two very distinct preference patterns. Preferences for group 1 (~65% of sample) were driven primarily by edible type, while for group 2 (~35% of sample) were driven almost entirely by THC potency. CONCLUSION This study found that consumer preferences for ~65% of consumers of cannabis edibles are being met through regulated channels. The remaining ~35% are driven by THC potency at levels that are not currently available on the licensed market. Attracting this market segment will require reviewing the risks and benefits of restricting THC package content.
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Affiliation(s)
- Jennifer Donnan
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Karissa Johnston
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Michael Coombs
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Maisam Najafizada
- Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Lisa Bishop
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
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Ozdemir S, Quaife M, Mohamed AF, Norman R. An Overview of Data Collection in Health Preference Research. THE PATIENT 2024:10.1007/s40271-024-00695-6. [PMID: 38662323 DOI: 10.1007/s40271-024-00695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
This paper focuses on survey administration and data collection methods employed for stated-preference studies in health applications. First, it describes different types of survey administration methods, encompassing web-based surveys, face-to-face (in-person) surveys, and mail surveys. Second, the concept of sampling frames is introduced, clarifying distinctions between the target population and survey frame population. The discussion then extends to different types of sampling methods, such as probability and non-probability sampling, along with an evaluation of potential issues associated with different sampling methods within the context of health preference research. Third, the paper provides information about different recruitment methods, including web-surveys, leveraging patient groups, and in-clinic recruitment. Fourth, a crucial aspect addressed is the calculation of response rate, with insights into determining an adequate response rate and strategies to improve response rates in stated-preference surveys. Lastly, the paper concludes by discussing data management plans and suggesting insights for future research in this field. In summary, this paper examines the nuanced aspects of survey administration and data collection methods in stated-preference studies, offering valuable guidance for researchers and practitioners in the health domain.
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Affiliation(s)
- Semra Ozdemir
- Department of Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, NC, USA.
| | | | | | - Richard Norman
- Curtin School of Population Health, Curtin University, Perth, Australia
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Donnan JR, Downey M, Johnston K, Najafizada M, Bishop LD. Examining attributes of retailers that influence where cannabis is purchased: a discrete choice experiment. J Cannabis Res 2024; 6:4. [PMID: 38331901 PMCID: PMC10851494 DOI: 10.1186/s42238-023-00204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/05/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND With the legalization of cannabis in Canada, consumers are presented with numerous purchase options. Licensed retailers are limited by the Cannabis Act and provincial regulations with respect to offering sales, advertising, location, maximum quantities, and information sharing in an effort to protect public health and safety. The degree these policies influence consumer purchase behavior will help inform regulatory refinement. METHODS A discrete choice experiment within a cross-sectional online survey was used to explore trade-offs consumers make when deciding where to purchase cannabis. Attributes included availability of sales/discounts, proximity, product information, customer service, product variety, and provincial regulation. Participants ≥ 19 years old who lived in Canada and purchased cannabis in the previous 12 months were recruited through an online market research survey panel. A multinomial logit (MNL) model was used for the base model, and latent class analysis was used to assess preference sub-groups. Key limitations included ordering effect, hypothetical bias, and framing effect. RESULTS The survey was completed by 1626 people, and the base model showed that customer service carried the most weight in purchase decisions, followed by proximity and availability of sales and discounts. There was considerable heterogeneity in preference patterns, with a five-group latent class model demonstrating best fit. Only one group (15% of sample) placed a high value on the store being provincially regulated, while three groups were willing to make a trade-off with regulation to access better customer service, product information, or closer proximity. One group preferred non-regulated sources (24% of sample); this group was also primarily driven by the availability of sales and discounts. Three groups (60.5% of sample) preferred online stores. CONCLUSION This study highlighted that there exists significant diversity with respect to the influence of consumer experiences on cannabis purchase behaviors. Modifications to cannabis retail regulations that focus on improving access to product information as well as reviewing limitations on sales and discounts could have the most impact for shifting customers to licensed retailers.
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Affiliation(s)
- Jennifer R Donnan
- School of Pharmacy, Memorial University of Newfoundland School of Pharmacy, 300 Prince Phillip Drive St. John's, NL, A1B 3V6, St. John's, Canada.
| | - Molly Downey
- Faculty of Science, Department of Psychology, Memorial University, St. John's, NL, Canada
| | - Karissa Johnston
- School of Pharmacy, Memorial University of Newfoundland School of Pharmacy, 300 Prince Phillip Drive St. John's, NL, A1B 3V6, St. John's, Canada
| | - Maisam Najafizada
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Lisa D Bishop
- School of Pharmacy, Memorial University of Newfoundland School of Pharmacy, 300 Prince Phillip Drive St. John's, NL, A1B 3V6, St. John's, Canada
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Rivara AC, Galárraga O, Selu M, Arorae M, Wang R, Faasalele-Savusa K, Rosen R, Hawley NL, Viali S. Identifying patient preferences for diabetes care: A protocol for implementing a discrete choice experiment in Samoa. PLoS One 2023; 18:e0295845. [PMID: 38134044 PMCID: PMC10745180 DOI: 10.1371/journal.pone.0295845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
In Samoa, adult Type 2 diabetes prevalence has increased within the past 30 years. Patient preferences for care are factors known to influence treatment adherence and are associated with reduced disease progression and severity. However, patient preferences for diabetes care, generally, are understudied, and other patient-centered factors such as willingness-to-pay (WTP) for diabetes treatment have never been explored in this setting. Discrete Choice Experiments (DCE) are useful tools to elicit preferences and WTP for healthcare. DCEs present patients with hypothetical scenarios composed of a series of multi-alternative choice profiles made up of attributes and levels. Patients choose a profile based on which attributes and levels may be preferable for them, thereby quantifying and identifying locally relevant patient-centered preferences. This paper presents the protocol for the design, piloting, and implementation of a DCE identifying patient preferences for diabetes care, in Samoa. Using an exploratory sequential mixed methods design, formative data from a literature review and semi-structured interviews with n = 20 Samoan adults living with Type 2 diabetes was used to design a Best-Best DCE instrument. Experimental design procedures were used to reduce the number of choice-sets and balance the instrument. Following pilot testing, the DCE is being administered to n = 450 Samoan adults living with diabetes, along with associated questionnaires, and anthropometrics. Subsequently, we will also be assessing longitudinally how preferences for care change over time. Data will be analyzed using progressive mixed Rank Order Logit models. The results will identify which diabetes care attributes are important to patients (p < 0.05), examine associations between participant characteristics and preference, illuminate the trade-offs participants are willing to make, and the probability of uptake, and WTP for specific attributes and levels. The results from this study will provide integral data useful for designing and adapting efficacious diabetes intervention and treatment approaches in this setting.
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Affiliation(s)
- Anna C. Rivara
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Omar Galárraga
- Department of Health Services Policy and Practice, and International Health Institute, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Melania Selu
- Obesity Lifestyle and Genetic Adaptations (OLaGA) Research Center, Apia, Samoa
| | - Maria Arorae
- Obesity Lifestyle and Genetic Adaptations (OLaGA) Research Center, Apia, Samoa
| | - Ruiyan Wang
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | - Rochelle Rosen
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Behavioral and Social Sciences, Brown University, School of Public Health, Providence, Rhode Island, United States of America
| | - Nicola L. Hawley
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Satupaitea Viali
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
- School of Medicine, National University of Samoa, Apia, Samoa
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Wang Y, Zhai P, Zhang Y, Jiang S, Chen G, Li S. Gauging Incentive Values and Expectations (G.I.V.E.) among Blood Donors for Nonmonetary Incentives: Developing a Preference Elicitation Instrument through Qualitative Approaches in Shandong, China. THE PATIENT 2023; 16:593-606. [PMID: 37523066 DOI: 10.1007/s40271-023-00639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Blood donation rates remain suboptimal in China necessitating the reform of the current nonmonetary incentive system to motivate donors. This study aims to identify relevant attributes and levels for nonmonetary incentives in repeated blood donation and provide insights for the development of preference elicitation instruments. METHODS A qualitative research process was employed, including a literature review, in-depth interviews, attribute ranking, focus group discussions, and cognitive interviews, to identify potential nonmonetary incentives for blood donation. The identified attributes were then incorporated into a discrete choice experiment (DCE) study design. The comprehensibility and acceptability of the DCE questionnaire were assessed through cognitive interviews and a pilot study. RESULTS Five nonmonetary incentive attributes were identified, including health examination, designated blood recipient, honor for donation, travel time, and gifts. The designated recipient of blood donation emerged as the most important motivator for future donations among the participants. The cognitive interviews and pilot study provided valuable feedback for refining the DCE questionnaire and ensuring its reliability. CONCLUSION This study contributes to the understanding of nonmonetary incentives for blood donation and highlights the importance of designated blood recipients, health examination, honor for donation, travel time, and gifts as potential motivators. Moreover, it emphasizes the value of employing cognitive interviews and pilot studies in the development and refinement of DCE questionnaires, ultimately enhancing the reliability and validity of preference elicitation instruments.
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Affiliation(s)
- Yu Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China
- Center for Health Preference Research, Shandong University, Jinan, Shandong, China
| | - Peicong Zhai
- Blood Center of Shandong Province, Jinan, Shandong, China
| | - Yue Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China
- Center for Health Preference Research, Shandong University, Jinan, Shandong, China
| | - Shan Jiang
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China.
- Center for Health Preference Research, Shandong University, Jinan, Shandong, China.
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Gonzalez JM, Ganguli A, Morgans AK, Tombal BF, Hotte SJ, Suzuki H, Bhadauria H, Oh M, Scales CD, Wallace MJ, Yang JC, George DJ. Discrete-Choice Experiment to Understand the Preferences of Patients with Hormone-Sensitive Prostate Cancer in the USA, Canada, and the UK. THE PATIENT 2023; 16:607-623. [PMID: 37566214 PMCID: PMC10570152 DOI: 10.1007/s40271-023-00638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Treatment options for patients with metastatic hormone-sensitive prostate cancer (mHSPC) have broadened, and treatment decisions can have a long-lasting impact on patients' quality of life. Data on patient preferences can improve therapeutic decision-making by helping physicians suggest treatments that align with patients' values and needs. OBJECTIVE This study aims to quantify patient preferences for attributes of chemohormonal therapies among patients with mHSPC in the USA, Canada, and the UK. METHODS A discrete-choice experiment survey instrument was developed and administered to patients with high- and very-high-risk localized prostate cancer and mHSPC. Patients chose between baseline androgen-deprivation therapy (ADT) alone and experimentally designed, hypothetical treatment alternatives representing chemohormonal therapies. Choices were analyzed using logit models to derive the relative importance of attributes for each country and to evaluate differences and similarities among patients across countries. RESULTS A total of 550 respondents completed the survey (USA, 200; Canada, 200; UK, 150); the mean age of respondents was 64.3 years. Treatment choices revealed that patients were most concerned with treatment efficacy. However, treatment-related convenience factors, such as route of drug administration and frequency of monitoring visits, were as important as some treatment-related side effects, such as skin rash, nausea, and fatigue. Patient preferences across countries were similar, although patients in Canada appeared to be more affected by concomitant steroid use. CONCLUSION Patients with mHSPC believe the use of ADT alone is insufficient when more effective treatments are available. Efficacy is the most significant driver of patient choices. Treatment-related convenience factors can be as important as safety concerns for patients.
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Affiliation(s)
- Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University School of Medicine, 300 W. Morgan Street, 27701, Durham, NC, USA.
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
| | - Arijit Ganguli
- Medical Affairs, Astellas Pharma Inc., Northbrook, IL, USA
| | | | - Bertrand F Tombal
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Sebastien J Hotte
- Department of Oncology, McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Sakura City, Chiba, Japan
| | | | - Mok Oh
- Medical Affairs, Astellas Pharma Inc., Northbrook, IL, USA
| | - Charles D Scales
- Department of Population Health Sciences, Duke University School of Medicine, 300 W. Morgan Street, 27701, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Urology, Duke University School of Medicine, Durham, NC, USA
| | - Matthew J Wallace
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jui-Chen Yang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Daniel J George
- Department of Population Health Sciences, Duke University School of Medicine, 300 W. Morgan Street, 27701, Durham, NC, USA
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Gonzalez JM, Grover K, Leblanc TW, Reeve BB. Did a bot eat your homework? An assessment of the potential impact of bad actors in online administration of preference surveys. PLoS One 2023; 18:e0287766. [PMID: 37796861 PMCID: PMC10553355 DOI: 10.1371/journal.pone.0287766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/13/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Online administration of surveys has a number of advantages but can also lead to increased exposure to bad actors (human and non-human bots) who can try to influence the study results or to benefit financially from the survey. We analyze data collected through an online discrete-choice experiment (DCE) survey to evaluate the likelihood that bad actors can affect the quality of the data collected. METHODS We developed and fielded a survey instrument that included two sets of DCE questions asking respondents to select their preferred treatments for multiple myeloma therapies. The survey also included questions to assess respondents' attention while completing the survey and their understanding of the DCE questions. We used a latent-class model to identify a class associated with perverse preferences or high model variance, and the degree to which the quality checks included in the survey were correlated with class membership. Class-membership probabilities for the problematic class were used as weights in a random-parameters logit to recover population-level estimates that minimizes exposure to potential bad actors. RESULTS Results show a significant proportion of respondents provided answers with a high degree of variability consistent with responses from bad actors. We also found that a wide-ranging selection of conditions in the survey screener is more consistent with choice patterns expected from bad actors looking to qualify for the study. The relationship between the number of incorrect answers to comprehension questions and problematic choice patterns peaked around 5 out of 10 questions. CONCLUSIONS Our results highlight the need for a robust discussion around the appropriate way to handle bad actors in online preference surveys. While exclusion of survey respondents must be avoided under most circumstances, the impact of "bots" on preference estimates can be significant.
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Affiliation(s)
- Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Kiran Grover
- Icahn School of Medicine, Mount Sinai, New York, New York, United States of America
| | - Thomas W. Leblanc
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Bryce B. Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
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Noto S, Murata T, Saito S, Watanabe T, Kobayashi M. Preferences for Rehabilitation in Persons with a History of Stroke: A Discrete Choice Experiment. Patient Prefer Adherence 2023; 17:1611-1620. [PMID: 37465057 PMCID: PMC10350424 DOI: 10.2147/ppa.s416699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/08/2023] [Indexed: 07/20/2023] Open
Abstract
Objective To investigate the preferences of persons with a history of stroke for various attributes of rehabilitation using a discrete choice experiment (DCE). Design Cross-sectional study. Setting A web-based survey. Participants A total of 600 adults with a history of stroke who were not asked whether or not they had participated in previous rehabilitation. Intervention None. Main Outcome Measures Preference weights by attribute ie, treatment time (30 minutes, one hour, one and a half hours), treatment content (walking exercises, activities of daily living; ADL exercises), priority treatment of paralyzed limbs (upper extremity, lower upper extremity), treatment location (hospital visit, home visit), therapist gender, and out-of-pocket costs for stroke rehabilitation using discrete choice experiment. Results The most common self-reported diagnosis was cerebral infarction (408 patients, 68%). The mean age was 62.0 ± 9.8 years, and 515 (85.8%) were male. Of the five attributes, excluding out-of-pocket costs, the highest relative importance score was treatment location (0.331), followed by treatment time (0.304). Among the rehabilitation programs, the statistically significant coefficients calculated were one hour of therapy (0.173, 95% CI = 0.088-0.258), hospital visits (0.241, 95% CI = 0.180-0.303), and female therapists (0.186, 95% CI = 0.125-0. 247). No significant differences were obtained regarding the treatment contents or the paralyzed limb to be treated. Conclusion A discrete choice experiment revealed that persons with a history of stroke prefer a one-hour hospital rehabilitation program with a female therapist, with cost being a major consideration for rehabilitation. The results of this study may provide useful information for rehabilitation professionals.
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Affiliation(s)
- Shinichi Noto
- Department of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | | | | | - Takahiro Watanabe
- Rehabilitation Center, Niigata University Medical and Dental General Hospital, Niigata, Japan
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Donnan JR, Johnston K, Coombs M, Najafizada M, Bishop LD. Exploring Consumer Preferences for Cannabis Vaping Products to Support Public Health Policy: A Discrete Choice Experiment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:651-659. [PMID: 37060511 DOI: 10.1007/s40258-023-00804-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Phase two of cannabis legalisation in Canada brought cannabis vaping products to the market. This decision was controversial due to an outbreak of vaping cannabis use-associated lung injury. This resulted in three provinces banning the sale of cannabis vaping products causing inequitable access. This study sought to explore consumer preferences for cannabis vaping products to inform cannabis policy. METHODS We used a discrete choice experiment to explore consumer preferences for attributes of cannabis vaping products. Attributes included type of device, price, tetrahydrocannabinol (THC) potency, vape liquid content, product recommendations and Health Canada regulation. Participants lived in Canada, were aged ≥ 19 years, and had purchased a cannabis vape in the last 12 months. A multinomial logit (MNL) model was used for the base model, and latent class analysis to assess preference sub-groups. RESULTS In total, 384 participants completed the survey; the MNL model showed that price and potency were the most important attributes. A three-group latent class model showed that ~ 40% of the sample was driven primarily by Health Canada Regulation and were willing to pay $56 more for a product that was regulated compared to one that was not. About 33% of the sample was driven by price, and 26% was driven by type of device. CONCLUSION While regulated status by Health Canada was most important to some consumers (~ 40%), nearly 60% of the sample were willing to make trade-offs in regulated status for products with a lower price. Therefore, policymakers need to consider the broader public health implications of banning cannabis vapes in some regions.
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Affiliation(s)
- Jennifer R Donnan
- School of Pharmacy, Memorial University of Newfoundland, NL, St. John's, Canada.
| | - Karissa Johnston
- School of Pharmacy, Memorial University of Newfoundland, NL, St. John's, Canada
| | - Michael Coombs
- School of Pharmacy, Memorial University of Newfoundland, NL, St. John's, Canada
| | - Maisam Najafizada
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Lisa D Bishop
- School of Pharmacy, Memorial University of Newfoundland, NL, St. John's, Canada
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Genie MG, Ryan M, Krucien N. Keeping an eye on cost: What can eye tracking tell us about attention to cost information in discrete choice experiments? HEALTH ECONOMICS 2023; 32:1101-1119. [PMID: 36737875 DOI: 10.1002/hec.4658] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Concern has been expressed about including a cost attribute within discrete choice experiments (DCEs) when individuals do not have to pay at the point of consumption. We use eye tracking to investigate attention to cost when valuing publicly financed health care. One-hundred and four individuals completed a DCE concerned with preferences for UK general practitioner appointments: 51 responded to a DCE with cost included and 53 to the same DCE without cost. Eye-movements were tracked whilst respondents completed the DCE. We assessed if respondents pay attention to cost. We then compare fixation time (FT) on attributes, eye movement patterns and mental effort across the experimental groups. Results are encouraging for the inclusion of cost in DCEs valuing publicly provided healthcare. Most respondents gave visual attention to the cost attribute most of the time. Average FT on multi-attribute tasks increased by 44% in the cost DCE, with attention to non-monetary attributes increasing by 22%. Including cost led to more structured decision-making and did not increase mental effort. Acceptability of the cost attribute and difficulty of choice tasks were predictors of cost information processing, highlighting the importance of both motivating the cost attribute and considering difficulty of the tasks when developing DCEs.
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Affiliation(s)
- Mesfin G Genie
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Health Outcomes Research and Policy, Auburn University, Alabama, Auburn, USA
- Value in Health Economics and Policy Group, University of Newcastle, Newcastle, Australia
| | - Mandy Ryan
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Panchal R, Nguyen D, Ghule P, Li N, Giannouchos T, Pan RJ, Biskupiak J, Britton L, Nohavec R, Slager S, Ngorsuraches S, Brixner D. Understanding patient cost-sharing thresholds for diabetes treatment attributes via a discrete choice experiment. J Manag Care Spec Pharm 2023; 29:139-150. [PMID: 36705280 PMCID: PMC10387929 DOI: 10.18553/jmcp.2023.29.2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND: The process used to prefer certain products across drug classes for diabetes is generally focused on comparative effectiveness and cost. However, payers rarely tie patient preference for treatment attributes to formulary management resulting in a misalignment of value defined by providers, payers, and patients. OBJECTIVES: To explore patients' willingness to pay (WTP) for the predetermined high-value and low-value type 2 diabetes mellitus (T2DM) treatments within a health plan. METHODS: A cross-sectional discrete choice experiment (DCE) survey was used to determine patient preference for the benefit, risk, and cost attributes of T2DM treatments. A comprehensive literature review of patient preference studies in diabetes and a review of guidelines and medical literature identified study attributes. Patients and diabetes experts were interviewed and instructed to identify, prioritize, and comment on which attributes of diabetes treatments were most important to T2DM patients. The patients enrolled in a health plan were asked to respond to the survey. A multinomial logit model was developed to determine the relative importance and the patient's WTP of each attribute. The patients' relative values based on WTPs for T2DM treatments were calculated and compared with the treatments by a health plan. RESULTS: A total of 7 attributes were selected to develop a web-based DCE questionnaire survey. The responses from a total of 58 patients were analyzed. Almost half (48.3%) of the respondents took oral medications and injections for T2DM. The most prevalent side effects due to diabetes medications were gastrointestinal (43.1%), followed by weight gain (39.7%) and nausea (32.8%). Patients were willing to pay more for treatments with proven cardiovascular benefit and for the risk reduction of hospitalization from heart failure. On the other hand, they would pay less for treatments with higher gastrointestinal side effects. Patients were willing to pay the most for sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide 1 receptor agonist agents and the least for dipeptidyl peptidase-4 inhibitors and thiazolidinediones. CONCLUSIONS: This study provides information to better align patient, provider, and payer preferences in both benefit design and value-based formulary strategy for diabetes treatments. A preferred placement of treatments with cardiovascular benefits and lower adverse gastrointestinal side effects may lead to increased adherence to medications and improved clinical outcomes at a lower overall cost to both patients and their health plan. DISCLOSURES: This study was supported by a grant from the PhRMA Foundation.
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Affiliation(s)
- Rupesh Panchal
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City.,University of Utah Health Plans, Murray
| | - Danielle Nguyen
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
| | - Priyanka Ghule
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
| | - Niying Li
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
| | | | - Raymond J Pan
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
| | - Joseph Biskupiak
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
| | - Laura Britton
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City.,University of Utah Health Plans, Murray
| | - Robert Nohavec
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City.,University of Utah Health Plans, Murray
| | - Stacey Slager
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
| | | | - Diana Brixner
- Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City
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Evaluation of the clinical utility of the PromarkerD in-vitro test in predicting diabetic kidney disease and rapid renal decline through a conjoint analysis. PLoS One 2022; 17:e0271740. [PMID: 35913946 PMCID: PMC9342737 DOI: 10.1371/journal.pone.0271740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/06/2022] [Indexed: 11/19/2022] Open
Abstract
Background Early identification of patients at risk of developing diabetic kidney disease or rapid renal decline is imperative for appropriate patient management, but traditional methods of predicting renal decline are limited. Objective This study evaluated the impact of PromarkerD, a biomarker-based blood test predicting the risk of diabetic kidney disease (DKD) and rapid renal decline. Methods Conjoint analysis clarified the importance of PromarkerD and other patient attributes to physician decisions for type 2 diabetes patients. Forty-two patient profiles were generated, with varying levels of albuminuria, estimated glomerular filtration rate (eGFR), blood pressure, hemoglobin A1c (HbA1c), age, and PromarkerD result. A web-based survey asked each physician to make monitoring/treatment decisions about eight randomly selected profiles. Data were analyzed using multivariable logit models. Results Two hundred three primary care physicians and 197 endocrinologists completed the survey. PromarkerD result was most important for increasing the frequency of risk factor monitoring. PromarkerD was second to HbA1c in importance for deciding to prescribe sodium/glucose cotransporter-2 inhibitors (SGLT2s) with a DKD indication, second to blood pressure for increasing the dose of lisinopril, and second to eGFR for replacing ibuprofen with a non-nephrotoxic medication. Compared with no PromarkerD results, a high-risk PromarkerD result was associated with significantly higher odds of increasing monitoring frequency (odds ratio [OR]: 2.56, 95% confidence interval: 1.90–3.45), prescribing SGLT2s (OR: 1.98 [1.56–2.52]), increasing lisinopril dose (OR: 1.48 [1.17–1.87]), and replacing ibuprofen (OR: 1.78 [1.32–2.40]). A low-risk PromarkerD result was associated with significantly lower odds of increasing monitoring frequency (OR: 0.48 [0.37–0.64]), prescribing SGLT2s (OR: 0.70 [0.56–0.88]), and replacing ibuprofen (OR: 0.75 [0.57–0.99]). Conclusion PromarkerD could increase adoption of renoprotective interventions in patients at high risk for renal decline and lower the likelihood of aggressive treatment in those at low risk. Further studies are needed to assess patient outcomes with PromarkerD in real-world practice.
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Geerling R, Gray SM, Holmes‐Truscott E, Speight J. 'I need someone to believe in me and walk the journey with me': A qualitative analysis of preferred approaches to weight management discussions in clinical care among adults with type 2 diabetes. Diabet Med 2022; 39:e14790. [PMID: 35030281 PMCID: PMC9305755 DOI: 10.1111/dme.14790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/11/2022] [Indexed: 01/19/2023]
Abstract
AIMS To explore the preferences of adults with type 2 diabetes regarding the approach to weight management discussions in clinical care. METHODS Online survey of Australian adults with type 2 diabetes, recruited via a national diabetes registry. Three open-ended questions explored participants' experiences and ideal approach to discussing weight management with health professionals. Data subjected to inductive thematic template analysis. RESULTS Participants were 254 adults, 58% aged 60+ years, 52% women and 35% insulin-treated. Five themes were developed to categorise participants' preferences for, as well as differing experiences of, weight management discussions: (1) collaborative, person-centred care: working together to make decisions and achieve outcomes, taking personal context into consideration; (2) balanced communication: open, clear messages encouraging action, empathy and kindness; (3) quality advice: knowledgeable health professionals, providing specific details or instructions; (4) weight management intervention: suitable modalities to address weight management and (5) system-wide support: referral and access to appropriate multi-disciplinary care. CONCLUSIONS Participants expressed preferences for discussing weight management in collaborative, person-centred consultations, with quality advice and personalised interventions across the health system, delivered with empathy. By adopting these recommendations, health professionals may build constructive partnerships with adults with type 2 diabetes and foster weight management.
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Affiliation(s)
- Ralph Geerling
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in DiabetesDiabetes VictoriaMelbourneVictoriaAustralia
| | - Shikha M. Gray
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in DiabetesDiabetes VictoriaMelbourneVictoriaAustralia
| | - Elizabeth Holmes‐Truscott
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in DiabetesDiabetes VictoriaMelbourneVictoriaAustralia
| | - Jane Speight
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in DiabetesDiabetes VictoriaMelbourneVictoriaAustralia
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Enzing JJ, Himmler S, Knies S, Brouwer WBF. Do Profit Margins of Pharmaceuticals Influence Reimbursement Decisions? A Discrete Choice Experiment Among Dutch Healthcare Decision Makers. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:222-229. [PMID: 35094795 DOI: 10.1016/j.jval.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/05/2021] [Accepted: 08/18/2021] [Indexed: 05/19/2023]
Abstract
OBJECTIVES This study aimed to investigate whether the profit margins of pharmaceuticals would influence the outcome of reimbursement decisions within the Dutch policy context. METHODS We conducted a discrete choice experiment among 58 Dutch decision makers. In 20 choice sets, we asked respondents to indicate which of 2 pharmaceutical treatment options they would select for reimbursement. Options were described using 5 attributes (disease severity, incremental costs per quality-adjusted life-year, health gain, budget impact, and profit margin) with 3 levels each. Additionally, cognitive debriefing questions were presented, and for validation debriefing, interviews were conducted. Choice data were analyzed using mixed logit models, also to calculate marginal effects and choice probabilities. RESULTS Results indicated that the specified levels of profit margins significantly influenced choices made. Decision makers were less likely to reimburse a product with a higher profit margin. The relative importance of profit margins was lower than that of the included traditional health technology assessment criteria, but not negligible. When asked directly, 61% of respondents indicated that profit margin should play a role in reimbursement decision making, although concerns about feasibility and the connection to price negotiations were voiced. CONCLUSIONS Our results suggest that if available to decision makers the profit margin of pharmaceutical products would influence reimbursement decisions within the Dutch policy context. Higher profit margins would reduce the likelihood of reimbursement. Whether adding profit margin as an additional, explicit criterion to the health technology assessment decision framework would be feasible and desirable is open to further exploration.
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Affiliation(s)
- Joost J Enzing
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Zorginstituut Nederland, Diemen, The Netherlands.
| | - Sebastian Himmler
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Saskia Knies
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Zorginstituut Nederland, Diemen, The Netherlands
| | - Werner B F Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Lv Y, Ren R, Tang C, Song K, Li S, Wang H. Preferences for Patients with Type 2 Diabetes Mellitus for Medications in Shandong Province, China: A Discrete Choice Experiment. Patient Prefer Adherence 2022; 16:2335-2344. [PMID: 36046499 PMCID: PMC9423121 DOI: 10.2147/ppa.s367985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate preferences for medications among patients with type 2 diabetes mellitus (T2DM) from urban community health stations or rural village clinics in Shandong province, China. METHODS We use a discrete choice experiment (DCE) to measure the medication preferences. Each patient completed six DCE choice sets. The attributes for the DCE questionnaire include mode of administration, out-of-pocket medication cost per month, fasting blood glucose control effect and frequency of hypoglycemia events. The conditional logit model (Clogit) and mixed logit model (MXL) were used to evaluate choice data. RESULTS A total of 887 patients with T2DM completed the survey. The mean age of participants was 64 years, 36.42% experienced complications, and the mean duration of diabetes was about 8 years. Overall, patients' ideal medication would not have hypoglycemia events, provide normal fasting glucose levels, have oral medication three times a day and lower monthly medication cost. Patients prioritized the frequency of hypoglycemia events (β=15.055, P < 0.01) and were willing to spend CNY 393.10 per month to avoid hypoglycemia events. For patients with higher educational levels and with longer diagnosis time, the effect of fasting blood glucose was more relevant than all other outcomes. CONCLUSION This study provides information on T2DM patients' preference for medications. Our results suggest that clinical doctors should present patients with a variety of pharmaceutical characteristics and include their preference into medication decision, which will improve patient adherence and health outcomes.
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Affiliation(s)
- Yuyu Lv
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, People’s Republic of China
| | - Ru Ren
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, People’s Republic of China
- Center for Health Preference Research, Shandong University, Jinan, People’s Republic of China
| | - Chengxiang Tang
- Macquarie University Centre for the Health Economy, Macquarie University Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Kuimeng Song
- School of Health Care Security, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, People’s Republic of China
| | - Shunping Li
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, People’s Republic of China
- Center for Health Preference Research, Shandong University, Jinan, People’s Republic of China
- Correspondence: Shunping Li; Haipeng Wang, Centre for Health Management and Policy Research, Wenhua Xi Road 44, Jinan, Shandong Province, 250012, People’s Republic of China, Tel +86-131-8893-4998, +86-186-6899-6362, Email ;
| | - Haipeng Wang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, People’s Republic of China
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Houwen T, Vugts MAP, Lansink KWW, Theeuwes HP, Neequaye N, Beerekamp MSH, Joosen MCW, de Jongh MAC. Developing mHealth to the Context and Valuation of Injured Patients and Professionals in Hospital Trauma Care: Qualitative and Quantitative Formative Evaluations (Preprint). JMIR Hum Factors 2021; 9:e35342. [PMID: 35723928 PMCID: PMC9254041 DOI: 10.2196/35342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Trauma care faces challenges to innovating their services, such as with mobile health (mHealth) app, to improve the quality of care and patients’ health experience. Systematic needs inquiries and collaborations with professional and patient end users are highly recommended to develop and prepare future implementations of such innovations. Objective This study aimed to develop a trauma mHealth app for patient information and support in accordance with the Center for eHealth Research and Disease Management road map and describe experiences of unmet information and support needs among injured patients with trauma, barriers to and facilitators of the provision of information and support among trauma care professionals, and drivers of value of an mHealth app in patients with trauma and trauma care professionals. Methods Formative evaluations were conducted using quantitative and qualitative methods. Ten semistructured interviews with patients with trauma and a focus group with 4 trauma care professionals were conducted for contextual inquiry and value specification. User requirements and value drivers were applied in prototyping. Furthermore, a complementary quantitative discrete choice experiment (DCE) was conducted with 109 Dutch trauma surgeons, which enabled triangulation on value specification results. In the DCE, preferences were stated for hypothetical mHealth products with various attributes. Panel data from the DCE were analyzed using conditional and mixed logit models. Results Patients disclosed a need for more psychosocial support and easy access to more extensive information on their injury, its consequences, and future prospects. Health care professionals designated workload as an essential issue; a digital solution should not require additional time. The conditional logit model of DCE results suggested that access to patient app data through electronic medical record integration (odds ratio [OR] 3.3, 95% CI 2.55-4.34; P<.001) or a web viewer (OR 2.3, 95% CI 1.64-3.31; P<.001) was considered the most important for an mHealth solution by surgeons, followed by the inclusion of periodic self-measurements (OR 2, 95% CI 1.64-2.46; P<.001), the local adjustment of patient information (OR 1.8, 95% CI 1.42-2.33; P<.001), local hospital identification (OR 1.7, 95% CI 1.31-2.10; P<.001), complication detection (OR 1.5, 95% CI 1.21-1.84; P<.001), and the personalization of rehabilitation through artificial intelligence (OR 1.4, 95% CI 1.13-1.62; P=.001). Conclusions In the context of trauma care, end users have many requirements for an mHealth solution that addresses psychosocial functioning; dependable information; and, possibly, a prediction of how a patient’s recovery trajectory is evolving. A structured development approach provided insights into value drivers and facilitated mHealth prototype enhancement. The findings imply that iterative development should move on from simple and easily implementable mHealth solutions to those that are suitable for broader innovations of care pathways that most—but plausibly not yet all—end users in trauma care will value. This study could inspire the trauma care community.
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Affiliation(s)
- Thymen Houwen
- Network Emergency Care Brabant, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | - Miel A P Vugts
- Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Koen W W Lansink
- Department of Trauma Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | - Hilco P Theeuwes
- Department of Trauma Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | - Nicky Neequaye
- Network Emergency Care Brabant, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | | | - Margot C W Joosen
- Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Mariska A C de Jongh
- Network Emergency Care Brabant, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
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Szinay D, Cameron R, Naughton F, Whitty JA, Brown J, Jones A. Understanding Uptake of Digital Health Products: Methodology Tutorial for a Discrete Choice Experiment Using the Bayesian Efficient Design. J Med Internet Res 2021; 23:e32365. [PMID: 34633290 PMCID: PMC8546533 DOI: 10.2196/32365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/24/2021] [Accepted: 09/18/2021] [Indexed: 02/06/2023] Open
Abstract
Understanding the preferences of potential users of digital health products is beneficial for digital health policy and planning. Stated preference methods could help elicit individuals' preferences in the absence of observational data. A discrete choice experiment (DCE) is a commonly used stated preference method-a quantitative methodology that argues that individuals make trade-offs when engaging in a decision by choosing an alternative of a product or a service that offers the greatest utility, or benefit. This methodology is widely used in health economics in situations in which revealed preferences are difficult to collect but is much less used in the field of digital health. This paper outlines the stages involved in developing a DCE. As a case study, it uses the application of a DCE to reveal preferences in targeting the uptake of smoking cessation apps. It describes the establishment of attributes, the construction of choice tasks of 2 or more alternatives, and the development of the experimental design. This tutorial offers a guide for researchers with no prior knowledge of this research technique.
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Affiliation(s)
- Dorothy Szinay
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Rory Cameron
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- National Institute for Health Research, Applied Research Collaboration East of England, Cambridge, United Kingdom
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Jennifer A Whitty
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- National Institute for Health Research, Applied Research Collaboration East of England, Cambridge, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Andy Jones
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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Pollard S, Weymann D, Dunne J, Mayanloo F, Buckell J, Buchanan J, Wordsworth S, Friedman JM, Stockler-Ipsiroglu S, Dragojlovic N, Elliott AM, Harrison M, Lynd LD, Regier DA. Toward the diagnosis of rare childhood genetic diseases: what do parents value most? Eur J Hum Genet 2021; 29:1491-1501. [PMID: 33903739 PMCID: PMC8484431 DOI: 10.1038/s41431-021-00882-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/18/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
Genomic testing is becoming routine for diagnosing rare childhood genetic disease. Evidence underlying sustainable implementation is limited, focusing on short-term endpoints such as diagnostic yield, unable to fully characterize patient and family valued outcomes. Although genomic testing is becoming widely available, evidentiary and outcomes uncertainty persist as key challenges for implementation. We examine whether the current evidence base reflects public tolerance for uncertainty for genomics to diagnose rare childhood genetic disease. We conducted focus groups with general population parents in Vancouver, Canada, and Oxford, United Kingdom, to discuss expectations and concerns related to genomic testing to diagnose rare childhood genetic disease. Applying a purposive sampling technique, recruitment continued until thematic saturation was reached. Transcripts were analysed using thematic analysis. Thirty-three parents participated across four focus groups. Participants valued causal diagnoses alongside management strategies to improve patient health and wellbeing. Further, participants valued expanding the evidence base to reduce evidentiary uncertainty while ensuring security of information. Willingness to pay out of pocket for testing reflected perceived familial health benefit. Diagnostic yield fails to fully capture valued outcomes, and efforts to resolve uncertainty better reflect public priorities. Evaluations of genomic testing that fully integrate valued endpoints are necessary to ensure consistency with best practices and public willingness to accept the uncertain familial benefit.
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Affiliation(s)
- Samantha Pollard
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, Canada
| | - Deirdre Weymann
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, Canada
| | - Jessica Dunne
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, Canada
| | - Fatemeh Mayanloo
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, Canada
| | - John Buckell
- grid.4991.50000 0004 1936 8948Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - James Buchanan
- grid.4991.50000 0004 1936 8948Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Sarah Wordsworth
- grid.4991.50000 0004 1936 8948Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Jan M. Friedman
- grid.17091.3e0000 0001 2288 9830Department of Medical Genetics, University of British Columbia, Vancouver, Canada ,grid.414137.40000 0001 0684 7788BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Sylvia Stockler-Ipsiroglu
- grid.414137.40000 0001 0684 7788BC Children’s Hospital Research Institute, Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada ,grid.414137.40000 0001 0684 7788Division of Biochemical Genetics, BC Children’s Hospital, Vancouver, Canada
| | - Nick Dragojlovic
- grid.17091.3e0000 0001 2288 9830Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Alison M. Elliott
- grid.17091.3e0000 0001 2288 9830Department of Medical Genetics, University of British Columbia, Vancouver, Canada ,grid.414137.40000 0001 0684 7788BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Mark Harrison
- grid.17091.3e0000 0001 2288 9830Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada ,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, Canada
| | - Larry D. Lynd
- grid.17091.3e0000 0001 2288 9830Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada ,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, Canada
| | - Dean A. Regier
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830School of Population and Public Health, University of British Columbia, Vancouver, Canada
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22
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Pérez-Troncoso D, Epstein DM, Castañeda-García JA. Consumers' Preferences and Willingness to Pay for Personalised Nutrition. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:757-767. [PMID: 33900567 DOI: 10.1007/s40258-021-00647-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Personalised nutrition (PN) has great potential for disease prevention, particularly if coupled with the power and accessibility of mobile technology. However, success of PN interventions will depend on the willingness of users to subscribe. This study investigates the factors associated with potential users' perceived value of PN and heterogeneity in these values. METHODS A discrete choice experiment was carried out in a representative sample (N = 429 valid responses) from the adult population in Spain. The results were analysed in line with McFadden's Random Utility Theory, using conditional and mixed logit models in addition to a latent class logit model. RESULTS The conditional and mixed logit models revealed the existence of a significant preference and willingness to pay for personalised nutrition, but the effect on average was not large for the highest level of personalisation. The latent class logit revealed four classes of respondent: those who would be likely to pay for a high level of personalised nutrition service, those who would use it if it were heavily subsidised, those who would use only a basic nutrition service, and those who would not be willing to engage. These results could be useful for the design and targeting of effective personalised nutrition services. CONCLUSIONS Over half of adults currently perceive some individual benefit in a high level of PN, which may justify some degree of public subsidy in investment and delivery of such a service.
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Affiliation(s)
| | - David M Epstein
- Department of Applied Economics, University of Granada, Granada, Spain
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Edmunds K, Wall L, Brown S, Searles A, Shakeshaft AP, Doran CM. Exploring Community-Based Options for Reducing Youth Crime. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105097. [PMID: 34065813 PMCID: PMC8150417 DOI: 10.3390/ijerph18105097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022]
Abstract
BackTrack is a multi-component, community-based intervention designed to build capacity amongst 14–17-year-old high risk young people. The aim of the current study seeks to explore community value and preferences for reducing youth crime and improving community safety using BackTrack in a rural setting in Armidale, New South Wales, Australia. The study design used discrete choice experiments (DCEs), designed in accordance with the 10-item checklist outlined by the International Society for Pharmacoeconomics and Outcomes Research. The DCE was pilot tested on 43 participants to test feasibility and comprehension. A revised version of the survey was subsequently completed by 282 people over a 12-day period between 30 May 2016 and 10 June 2016, representing a survey response rate of 35%. Ninety per cent of respondents were residents of Armidale, the local rural town where BackTrack was implemented. The DCE generated results that consistently demonstrated a preference for social programs to address youth crime and community safety in the Armidale area. Respondents chose BackTrack over Greater Police Presence 75% of the time with an annual benefit of Australian dollars (AUD) 150 per household, equivalent to a community benefit of AUD 2.04 million. This study estimates a strong community preference for BackTrack relative to more policing (a community willing to pay equivalent to AUD 2.04 million) highlighting the clear value of including community preferences when evaluating community-based programs for high-risk young people.
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Affiliation(s)
- Kim Edmunds
- Centre for Applied Health Economics, Griffith University, Nathan, QLD 4111, Australia;
| | - Laura Wall
- School of Psychology, University of Newcastle, Callaghan, NSW 2308, Australia; (L.W.); (S.B.)
| | - Scott Brown
- School of Psychology, University of Newcastle, Callaghan, NSW 2308, Australia; (L.W.); (S.B.)
| | - Andrew Searles
- Health Research Economics, Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW 2305, Australia;
| | - Anthony P. Shakeshaft
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, NSW 2502, Australia;
| | - Christopher M. Doran
- Cluster for Resilience and Wellbeing, Appleton Institute, Central Queensland University, Brisbane, QLD 4000, Australia
- Correspondence: ; Tel.: +61-412-935-084
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Sarikhani Y, Ostovar T, Rossi-Fedele G, Edirippulige S, Bastani P. A Protocol for Developing a Discrete Choice Experiment to Elicit Preferences of General Practitioners for the Choice of Specialty. Value Health Reg Issues 2021; 25:80-89. [PMID: 33845340 DOI: 10.1016/j.vhri.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/16/2020] [Accepted: 12/23/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Discrete choice experiment (DCE) has been increasingly used in studies investigating preferences of the health workforce. This pilot study aimed to provide a comprehensive protocol for design and quality assessment of a DCE to elicit preferences of general practitioners for the choice of specialty. METHODS We conducted 3 rigorous qualitative studies, including a review of literature, qualitative interviews, and focus group discussion to develop attributes and levels of the DCE. Then a D-efficient fractional factorial design was applied to generate choice tasks and to block them into 4 equal versions using SAS software. Two hundred and forty general practitioners participated in a pilot study conducted to evaluate the quality of the instrument using 7 tests. RESULTS The qualitative studies resulted in the development of 8 attributes and 24 levels. Experimental design led to the generation of 36 choice tasks divided into 4 blocks. The pilot study revealed that the instrument has validity and reliability and also indicated that the design is comprehensible and feasible. CONCLUSIONS This study provided an integrated, comprehensive framework for development and quality assessment of a DCE that could be used in other studies. The pilot study indicated that the instrument is of sufficient quality because it was developed using rigorous qualitative studies and accurate experimental design method.
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Affiliation(s)
- Yaser Sarikhani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Ostovar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Peivand Bastani
- Health Human Recourses Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
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25
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Janse S, Janssen E, Huwig T, Basu Roy U, Ferris A, Presley CJ, Bridges JFP. Line of therapy and patient preferences regarding lung cancer treatment: a discrete-choice experiment. Curr Med Res Opin 2021; 37:643-653. [PMID: 33571024 DOI: 10.1080/03007995.2021.1888707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A growing literature on patient preferences informs decisions in research, regulatory science, and value assessment, but few studies have explored how preferences vary across patients with differing treatment experience. We sought to quantify patient preferences for the benefits and risks of lung cancer treatment and test how preferences differed by line of therapy (LOT). METHODS Preferences were elicited using a discrete choice experiment (DCE) following rigorous patient and stakeholder engagement. The DCE spanned five attributes (each with three levels): progression-free survival (PFS), short-term side effects, long-term side effects, risk of developing late-onset side effects, and mode of administration (MOA) - each defined across 3 relevant levels. A D-efficient design was used to generate 3 survey blocks of 9 paired-profile choice tasks each and respondents were asked which profile they preferred and then if they preferred to have no treatment (opt-out). A mixed logit model, controlling for opt-out, was used to estimate preferences. Preferences and trade-offs between PFS and other attributes were compared across two groups: those receiving ≤1 LOT and those receiving ≥2 LOT. RESULTS Of the 466 participants, 42% received ≤1 LOT and 58% received ≥2 LOT. Stated preferences differed between the groups overall (p<.001) and specifically for 18 months of PFS (p<.001), moderate short-term side effects (p<.001), no long-term side effects (p=.03), and 30% chance of late-onset side effects (p=.02). Those receiving differing amounts of LOT were willing to trade different amounts of PFS to change from moderate to mild short-term side effects (p<.001), moderate to no (p<.001) and mild to no (p<.001) long-term side effects. There were also differing amounts of tradeoff acceptable between the groups for a 10% decrease in risk of late-onset side effects (p=.016), a decrease in MOA from infusion every 3 weeks to pills taken daily at any time (p=.005) and from pills taken daily without food to pills taken daily at any time (p<.001). CONCLUSION We demonstrate differences in preferences based on experience with LOT, suggesting that patient treatment experience may have an impact on their preferences. As patient preference data become an important component of treatment decision making, preference differences should be considered when recommending therapies at different stages in the treatment journey. Understanding patient preferences regarding treatment decisions is essential to informing shared decision-making and ensuring treatment plans are consistent with patients' goals.
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Affiliation(s)
- Sarah Janse
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ellen Janssen
- Center for Medical Technology Policy (CMTP), Baltimore, MD, USA
| | - Tanya Huwig
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | | | | | - Carolyn J Presley
- Department of Internal Medicine, Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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26
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Hollin IL, Janssen E, Kelley MA, Bridges JFP. Do people have differing motivations for participating in a stated-preference study? Results from a latent-class analysis. BMC Med Inform Decis Mak 2021; 21:44. [PMID: 33549068 PMCID: PMC7868025 DOI: 10.1186/s12911-021-01412-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Researchers and policy makers have long suspected that people have differing, and potentially nefarious, motivations for participating in stated-preference studies such as discrete-choice experiments (DCE). While anecdotes and theories exist on why people participate in surveys, there is a paucity of evidence exploring variation in preferences for participating in stated-preference studies. METHODS We used a DCE to estimate preferences for participating in preference research among an online survey panel sample. Preferences for the characteristics of a study to be conducted at a local hospital were assessed across five attributes (validity, relevance, bias, burden, time and payment) and described across three levels using a starring system. A D-efficient experimental design was used to construct three blocks of 12 choice tasks with two profiles each. Respondents were also asked about factors that motivated their choices. Mixed logistic regression was used to analyze the aggregate sample and latent class analysis identified segments of respondents. RESULTS 629 respondents completed the experiment. In aggregate "study validity" was most important. Latent class results identified two segments based on underlying motivations: a quality-focused segment (76%) who focused most on validity, relevance, and bias and a convenience-focused segment (24%) who focused most on reimbursement and time. Quality-focused respondents spent more time completing the survey (p < 0.001) and were more likely to identify data quality (p < 0.01) and societal well-being (p < 0.01) as motivations to participate. CONCLUSIONS This information can be used to better understand variability in motivations to participate in stated-preference surveys and the impact of motivations on response quality.
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Affiliation(s)
- Ilene L Hollin
- Department of Health Services Administration and Policy, Temple University College of Public Health, Ritter Annex, 1301 Cecil B. Moore Ave Rm. 537, Philadelphia, PA, 19122, USA.
| | - Ellen Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marcella A Kelley
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA.,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Chetty-Makkan CM, Hoffmann CJ, Charalambous S, Botha C, Ntshuntshe S, Nkosi N, Kim HY. Youth Preferences for HIV Testing in South Africa: Findings from the Youth Action for Health (YA4H) Study Using a Discrete Choice Experiment. AIDS Behav 2021; 25:182-190. [PMID: 32607914 DOI: 10.1007/s10461-020-02960-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We conducted a discrete choice experiment (DCE) and quantified preferences for HIV testing among South African youth (Nov 2018 to Mar 2019). Six attributes and levels were identified through qualitative methods: source of HIV information; incentive amount and type; social support; testing method; and location. Each participant chose one of two options that comprised six attributes across 18 questions. Conditional logistic regression estimated the degree of preference [β]. Of 130 participants, median age was 21 years (interquartile range 19-23 years), majority female (58%), and 85% previously tested for HIV. Testing alone over accompanied by a friend (β = 0.22 vs. - 0.35; p < 0.01); SMS text over paper brochures (β = 0.13 vs. - 0.10; p < 0.01); higher incentive values (R50) over no incentive (β = 0.09 vs. - 0.07; p = 0.01); and food vouchers over cash (β = 0.06 vs. β = - 0.08; p = 0.01) were preferred. Testing at a clinic or home and family encouragement were important. Tailoring HTS to youth preferences may increase HIV testing.
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Affiliation(s)
- Candice M Chetty-Makkan
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa.
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Christopher J Hoffmann
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
- John Hopkins University, Baltimore, USA
| | - Salome Charalambous
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Claire Botha
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
| | - Simphiwe Ntshuntshe
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
| | - Nolwazi Nkosi
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa
| | - Hae-Young Kim
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Department of Population Health, New York University School of Public Health, New York, USA
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28
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Hu Q, Hu H, Hu M, Yang Y, Wu Z, Zhou N. Patient Preferences For Specialty Pharmacy Services: A Stated Preference Discrete-Choice Experiment in China. Front Public Health 2020; 8:597389. [PMID: 33363089 PMCID: PMC7755860 DOI: 10.3389/fpubh.2020.597389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives: To survey, analyze, and ascertain the preferences for specialty pharmacy services among patients requiring complex care and to provide evidence to support specialty pharmacy service decision-making in China. Methods: To identify essential service attributes and levels, a review of the literature, discussions with specialty pharmacy managers and a pilot questionnaire were conducted. A D-efficient fractional factorial design was used to generate the discrete-choice experiment (DCE) questionnaire. A face-to-face survey of patients with chronic illness and their families or friends was conducted at three specialty pharmacies in Chengdu and Qingdao, China. A mixed logit model was used for estimation. Results: Six relevant attributes were identified and incorporated into the DCE questionnaire. A total of 417 participants completed the survey (mean age 43 years, 45.1% males), and 32.1% had lung cancer. The conditional relative importance showed that the most critical attribute was “frequency of telephone follow-up to monitor adverse drug reactions (ADRs), “followed by “mode of drug delivery,” “provider of medication guidance services,” and “availability of medical insurance consultation”; the least important attribute was “business hours.” A 1 min increase in time spent led to a 0.73% decrease in the probability that a service profile would be chosen. Negative preferences were noted for ADR monitoring by telephone follow-up once a year (β = −0.23, p < 0.001) and business hours [8:30–20:00 (Monday to Friday), 8:30–17:30 (weekend)] (β = −0.12, p < 0.001). Compared with women, men had a higher preference for service monitoring ADRs once every 3 months. Conclusions: Preference measurements showed that “frequency of telephone follow-up to monitor ADRs” had the most critical impact on decisions, followed by “mode of drug delivery.” Specialty pharmacies in China need to take these findings into account to improve their design to increase uptake and patient loyalty.
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Affiliation(s)
- Qinyuan Hu
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, China
| | - Haiyao Hu
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Ming Hu
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, China
| | - Yumei Yang
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, China
| | - Zhiang Wu
- Yeehong Business School, Shenyang Pharmaceutical University, Beijing, China
| | - Naitong Zhou
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, China
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Nittas V, Mütsch M, Braun J, Puhan MA. Self-Monitoring App Preferences for Sun Protection: Discrete Choice Experiment Survey Analysis. J Med Internet Res 2020; 22:e18889. [PMID: 33245282 PMCID: PMC7732707 DOI: 10.2196/18889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/12/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
Background The availability and use of health apps continues to increase, revolutionizing the way mobile health interventions are delivered. Apps are increasingly used to prevent disease, improve well-being, and promote healthy behavior. On a similar rise is the incidence of skin cancers. Much of the underlying risk can be prevented through behavior change and adequate sun protection. Self-monitoring apps have the potential to facilitate prevention by measuring risk (eg, sun intensity) and encouraging protective behavior (eg, seeking shade). Objective Our aim was to assess health care consumer preferences for sun protection with a self-monitoring app that tracks the duration and intensity of sun exposure and provides feedback on when and how to protect the skin. Methods We conducted an unlabeled discrete choice experiment with 8 unique choice tasks, in which participants chose among 2 app alternatives, consisting of 5 preidentified 2-level attributes (self-monitoring method, privacy control, data sharing with health care provides, reminder customizability, and costs) that were the result of a multistep and multistakeholder qualitative approach. Participant preferences, and thus, the relative importance of attributes and their levels were estimated using conditional logit modeling. Analyses consisted of 200 usable surveys, yielding 3196 observations. Results Our respondents strongly preferred automatic over manually operated self-monitoring (odds ratio [OR] 2.37, 95% CI 2.06-2.72) and no cost over a single payment of 3 Swiss francs (OR 1.72, 95% CI 1.49-1.99). They also preferred having over not having the option of sharing their data with a health care provider of their choice (OR 1.66, 95% CI 1.40-1.97), repeated over single user consents, whenever app data are shared with commercial thirds (OR 1.57, 95% CI 1.31-1.88), and customizable over noncustomizable reminders (OR 1.30, 95% CI 1.09-1.54). While most participants favored thorough privacy infrastructures, the attribute of privacy control was a relatively weak driver of app choice. The attribute of self-monitoring method significantly interacted with gender and perceived personal usefulness of health apps, suggesting that female gender and lower perceived usefulness are associated with relatively weaker preferences for automatic self-monitoring. Conclusions Based on the preferences of our respondents, we found that the utility of a self-monitoring sun protection app can be increased if the app is simple and adjustable; requires minimal effort, time, or expense; and has an interoperable design and thorough privacy infrastructure. Similar features might be desirable for preventive health apps in other areas, paving the way for future discrete choice experiments. Nonetheless, to fully understand these preference dynamics, further qualitative or mixed method research on mobile self-monitoring-based sun protection and broader preventive mobile self-monitoring is required. International Registered Report Identifier (IRRID) RR2-10.2196/16087
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Affiliation(s)
- Vasileios Nittas
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Margot Mütsch
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Julia Braun
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo Alan Puhan
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
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Guo N, Wang J, Nicholas S, Maitland E, Zhu D. Behavioral Differences in the Preference for Hepatitis B Virus Vaccination: A Discrete Choice Experiment. Vaccines (Basel) 2020; 8:vaccines8030527. [PMID: 32937824 PMCID: PMC7564078 DOI: 10.3390/vaccines8030527] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/25/2023] Open
Abstract
Understanding behavioral factors differences in the preferences for vaccinations can improve predictions of vaccine uptake rates and identify effective policy interventions to increase the demand for vaccinations. In this study, 353 adults in Shandong province in China were interviewed about their preferences for hepatitis B virus (HBV) vaccination. A discrete choice experiment (DCE) was employed to analyze the preference for HBV vaccinations, and a mixed logit model was used to estimate respondent preferences for vaccination attributes included in the DCE. While the protection rate against hepatitis B (HB), duration of protection, risk of side-effects, and vaccination cost were shown to influence adults’ preferences for HBV vaccination, adults valued “99% hepatitis B protection” above other attributes, followed by “20 years’ protection duration” and “1 in 150,000 risk of side-effects”. Individuals with lower time discount rates, non-overconfidence, or higher risk aversion were more likely to choose a vaccine. Lower risk aversion individuals showed a higher preference for lower risk of side-effects. Lower time discount rate individuals showed a higher preference for longer protection duration. Non-overconfidence individuals showed a higher preference for higher hepatitis B protection and cost. Interventions should be targeted to the behavioral determinants impeding vaccination.
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Affiliation(s)
- Na Guo
- China Population and Development Research Center, Beijing 100081, China;
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan 430072, China;
- Center for Health Economics and Management in School of Economics and Management, Wuhan University, Wuhan 430072, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW 2015, Australia;
- Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou 510420, China
- School of Economics and School of Management, Tianjin Normal University, Tianjin 300074, China
- Newcastle Business School, University of Newcastle, Newcastle, NSW 2015, Australia
| | | | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing 100191, China
- Correspondence:
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Sommer J, Dyczmons J, Grobosch S, Gontscharuk V, Vomhof M, Roden M, Icks A. Preferences of people with type 2 diabetes for telemedical lifestyle programmes in Germany: protocol of a discrete choice experiment. BMJ Open 2020; 10:e036995. [PMID: 32907900 PMCID: PMC7482475 DOI: 10.1136/bmjopen-2020-036995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/25/2020] [Accepted: 08/15/2020] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Telemedical lifestyle programmes for people with type 2 diabetes mellitus (T2DM) provide an opportunity to develop a healthier lifestyle and consequently to improve health outcomes. When implementing new programmes into standard care, considering patients' preferences may increase the success of the participants. This study aims to examine the preferences of people with T2DM with respect to telemedical lifestyle programmes, to analyse whether these preferences predict programme success and to explore the changes that may occur during a telemedical lifestyle intervention. METHODS AND ANALYSIS We outline the protocol of the development and assessment of a discrete choice experiment (DCE) to examine patient preferences in a telemedical lifestyle programme with regard to the functions of the online portal, communication, responsibilities, group activities and time requirements. To develop the design of the DCE, we conducted pilot work involving healthcare experts and in particular people with T2DM using cognitive pretesting. The final DCE is being implemented within a randomised controlled trial for investigating whether participation in a telemedical lifestyle intervention programme sustainably improves the HbA1c values in 850 members of a large German statutory health insurance with T2DM. Preferences are being assessed before and after participants complete the programme. The DCE data will be analysed using regression and latent class analyses. ETHICS AND DISSEMINATION The DCE study has been approved by the ethics committee of the medical faculty of the Heinrich Heine University Duesseldorf, registration number 2018-242-ProspDEuA, registered on 6 December 2018. The TeLIPro trial is registered at the US National Library of Medicine, registration number NCT03675919, registered on 15 September 2018. We aim to disseminate our results in peer-reviewed journals, at national and international conferences and among interested patient groups and the public.
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Affiliation(s)
- Jana Sommer
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Jan Dyczmons
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Sandra Grobosch
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Veronika Gontscharuk
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Division of Endocrinology and Diabetology, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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Crossnohere NL, Janse S, Janssen E, Bridges JFP. Comparing the Preferences of Patients and the General Public for Treatment Outcomes in Type 2 Diabetes Mellitus. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:89-100. [PMID: 32885395 DOI: 10.1007/s40271-020-00450-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Healthcare treatments and interventions are traditionally evaluated from the societal perspective, but a more patient-centric perspective has been proposed in recent years. We sought to compare preferences of patients and the general public for treatment outcomes of type 2 diabetes using both best-worst scaling (BWS) and rating approaches. METHODS A survey evaluating the treatment priorities for type 2 diabetes was conducted in the United States. Members of the general public and patients with type 2 diabetes were recruited from a nationally sampled panel. Participants indicated the importance of seven potential treatment outcomes (hypoglycemic events, glycated hemoglobin [A1c], weight loss, mental health, functioning, glycemic stability, and cardiovascular health) using (1) BWS case 1 and (2) a rating task. Preference differences from BWS prioritizations were explored using mixed logistic regression (BWS preference weights were probability re-scaled so that the weightings of the seven items collectively summed to 100). The consistency of scale between samples was explored using heteroskedastic conditional logistic regression of BWS data. Spearman rank correlation was used to compare standardized BWS preference weights and rating scores for each group. Both groups evaluated the BWS and rating activities using debriefing questions. RESULTS The public and patient samples included 314 and 313 respondents, respectively. The public was on average 16 years younger than patients (48 vs 64 years, P < 0.001). In BWS, patients and the public both ranked A1c, glycemic stability, and cardiovascular health within their top three outcomes. Patients valued the outcome A1c most highly and found it twice as important as did the public (41.0 vs 20.2, P < 0.001). The public valued cardiovascular health most highly, and found it to be twice as important than did patients (31.3 vs 17.4, P < 0.001). Patients were more consistent in their preferences than the public (λ = 1.66, P = 0.01). Preferences elicited using BWS and rating approaches were highly correlated for both patients (ρ = 0.96) and the public (ρ = 0.92). Patients were more likely than the public to endorse the BWS as easy to answer (P < 0.001), easy to understand (P < 0.001), consistent with preferences (P < 0.001), and relevant (P < 0.001). Both patients and the public found the rating activity easier to answer and understand, and more consistent with their preferences, than the BWS (P < 0.001). CONCLUSIONS We provide some of the first evidence demonstrating a difference in patient and public treatment priorities for diabetes. That patients were more consistent in their preferences than the public and found the BWS and Likert rating instruments more relevant suggests that patient priorities may be more appropriate than those of the general public in some medical decision-making contexts.
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Affiliation(s)
- Norah L Crossnohere
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 1800 Cannon Drive, Columbus, OH, 43210, USA. .,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Sarah Janse
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 1800 Cannon Drive, Columbus, OH, 43210, USA
| | - Ellen Janssen
- Center for Medical Technology Policy, World Trade Center Baltimore, 401 East Pratt Street, Suite 631, Baltimore, MD, 21202, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 1800 Cannon Drive, Columbus, OH, 43210, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
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Donnan J, Gao Z, Adey T, Walsh K, Pace D, Twells L. Prioritization for bariatric surgery: capturing Canadian patient preference weights using a discrete choice experiment. Surg Obes Relat Dis 2020; 16:751-759. [DOI: 10.1016/j.soard.2020.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 01/18/2023]
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Gater A, Reaney M, Findley A, Brun-Strang C, Burrows K, Nguyên-Pascal ML, Roborel de Climens A. Development and First Use of the Patient's Qualitative Assessment of Treatment (PQAT) Questionnaire in Type 2 Diabetes Mellitus to Explore Individualised Benefit-Harm of Drugs Received During Clinical Studies. Drug Saf 2020; 43:119-134. [PMID: 31679129 PMCID: PMC7007419 DOI: 10.1007/s40264-019-00877-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Individualised benefit–harm assessments can help identify patient-perceived benefits and harms of a treatment, and associated trade-offs that may influence patients’ willingness to use a treatment. This research presents the first use of a patient-reported outcome measure designed to assess patient-perceived benefits and disadvantages of drugs received during clinical studies. Methods The Patient’s Qualitative Assessment of Treatment (PQAT) was developed in English and cognitively tested with US (n = 4) and Canadian (n = 3) patients with type 1 and type 2 diabetes mellitus (T2DM). The revised version of the PQAT comprises three qualitative open-ended questions focused on the benefits and disadvantages of treatment and reasons why patients would choose to continue/discontinue treatment. A final quantitative question asks patients to evaluate the balance between benefits and disadvantages using a 7-point scale. The revised version of the questionnaire was administered as an exploratory endpoint in a phase II clinical trial for a new injectable treatment for T2DM. Qualitative data were analysed using thematic analysis, and relationships between qualitative and quantitative data were identified. Results Patient-reported benefits of treatment administered during the clinical trial included clinical markers of efficacy and subjective markers. Disadvantages reported by patients were mainly related to drug adverse effects or to the mode of administration. Of the 57 patients completing the PQAT, 70.2% reported being willing to continue treatment, with 59.6% reporting that the benefits outweighed the disadvantages. The reported benefits of feeling better and improved energy levels were more likely to be associated with a more positive ratio (70% and 71.4%, respectively), while the disadvantages of fatigue, headaches, and stomach pain were associated with a negative ratio and patients not being willing to continue the treatment. Conclusions The PQAT is a unique patient-reported outcome tool designed to aid understanding patients’ real experience of benefits and disadvantages of a treatment. It combines the richness of qualitative data with quantitative data—information valuable for various stakeholders to make well-informed treatment decisions. Trial Registration ClinicalTrials.gov identifier: NCT02973321. Electronic supplementary material The online version of this article (10.1007/s40264-019-00877-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adam Gater
- Adelphi Values, Adelphi Mill, Bollington, SK10 5JB, Cheshire, UK
| | - Matthew Reaney
- Sanofi Aventis Group, One Onslow Street, Guildford, GU1 4YS, Surrey, UK
| | - Amy Findley
- Adelphi Values, Adelphi Mill, Bollington, SK10 5JB, Cheshire, UK
| | | | - Kate Burrows
- Adelphi Values, Adelphi Mill, Bollington, SK10 5JB, Cheshire, UK
| | - My-Liên Nguyên-Pascal
- Sanofi Aventis Research Development, 1 Avenue Pierre Brossolette, 91385, Chilly-Mazarin Cedex, France
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Nittas V, Mütsch M, Puhan MA. Preferences for Sun Protection With a Self-Monitoring App: Protocol of a Discrete Choice Experiment Study. JMIR Res Protoc 2020; 9:e16087. [PMID: 32130187 PMCID: PMC7055859 DOI: 10.2196/16087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/15/2019] [Accepted: 11/26/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The incidence of sun-exposure-related skin conditions, such as melanoma, is a gradually increasing and largely preventable public health problem. Simultaneously, the availability of mobile apps that enable the self-monitoring of health behavior and outcomes is ever increasing. Inevitably, recent years have seen an emerging volume of electronic patient-generated health data (PGHD), as well as their targeted application across primary prevention areas, including sun protection and skin health. Despite their preventive potential, the actual impact of these apps relies on the engagement of health care consumers, who are primarily responsible for recording, sharing, and using their PGHD. Exploring preferences is a key step toward facilitating consumer engagement and ultimately realizing their potential. OBJECTIVE This paper describes an ongoing research project that aims to elicit the preferences of health care consumers for sun protection via app-based self-monitoring. METHODS A discrete choice experiment (DCE) will be conducted to explore how healthy consumers choose between two alternative preventive self-monitoring apps. DCE development and attribute selection were built on extensive qualitative work, consisting of the secondary use of a previously conducted scoping review, a rapid review of reviews, 13 expert interviews, and 12 health care consumer interviews, the results of which are reported in this paper. Following D-optimality criteria, a fractional factorial survey design was generated. The final DCE will be administered in the waiting room of a travel clinic, targeting a sample of 200 participants. Choice data will be analyzed with conditional logit and multinomial logit models, accounting for individual participant characteristics. RESULTS An ethics approval was waived by the Ethics Committee Zurich. The study started in September 2019 and estimated data collection and completion is set for January 2020. Five two-level attributes have been selected for inclusion in the DCE, addressing (1) data generation methods, (2) privacy control, (3) data sharing with general practitioner, (4) reminder timing, and (5) costs. Data synthesis, analysis, and reporting are planned for January and February 2020. Results are expected to be submitted for publication by February 2020. CONCLUSIONS Our results will target technology developers, health care providers, and policy makers, potentially offering some guidance on how to design or use sun-protection-focused self-monitoring apps in ways that are responsive to consumer preferences. Preferences are ultimately linked to engagement and motivation, which are key elements for the uptake and success of digital health. Our findings will inform the design of person-centered apps, while also inspiring future preference-eliciting research in the field of emerging and complex eHealth services. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/16087.
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Affiliation(s)
- Vasileios Nittas
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Margot Mütsch
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo Alan Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Janssen EM, Dy SM, Meara AS, Kneuertz PJ, Presley CJ, Bridges JFP. Analysis of Patient Preferences in Lung Cancer - Estimating Acceptable Tradeoffs Between Treatment Benefit and Side Effects. Patient Prefer Adherence 2020; 14:927-937. [PMID: 32581519 PMCID: PMC7276327 DOI: 10.2147/ppa.s235430] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/28/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Increased treatment options and longer survival for lung cancer have generated increased interest in patient preferences. Previous studies of patient preferences in lung cancer have not fully explored preference heterogeneity. We demonstrate a method to explore preference heterogeneity in the willingness of patients with lung cancer and caregivers to trade progression-free survival (PFS) with side effects. PATIENTS AND METHODS Patients and caregivers attending a national lung cancer meeting completed a discrete-choice experiment (DCE) designed through a collaboration with patients. Participants answered 13 choice tasks described across PFS, short-term side effects, and four long-term side effects. Side effects were coded as a one-level change in severity (none-mild, mild-moderate, or moderate-severe). A mixed logit model in willingness-to-pay space estimated preference heterogeneity in acceptable tradeoffs (time equivalents) between PFS and side effects. The study was reported following quality indicators from the United States Food and Drug Administration's patient preference guidance. RESULTS A total of 87 patients and 24 caregivers participated in the DCE. Participants would trade 3.7 month PFS (95% CI (CI): 3.3-4.1) for less severe functional long-term treatment side effects, 2.3 months for less severe physical long-term effects (CI: 1.9-2.8) and cognitive long-term effects (CI: 1.8-2.8), 0.9 months (CI: 0.4-1.4) for less severe emotional long-term effects, and 1.8 months (CI: 1.4-2.3) for less severe short-term side effects. Most participants (90%) would accept treatment with more severe functional long-term effects for 8.4 additional month PFS. CONCLUSION Participants would trade PFS for changes in short-term side effects and long-term side effects, although preference heterogeneity existed. Lung cancer treatments that offer less PFS but also less severe side effects might be acceptable to some patients.
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Affiliation(s)
- Ellen M Janssen
- Center for Medical Technology Policy, Baltimore, MD, USA
- Correspondence: Ellen M Janssen Research Director,Center for Medical Technology Policy, 401 East Pratt Street, Suite 631, Baltimore, MD21202, USATel +1 443-222-8775 Email
| | - Sydney M Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexa S Meara
- Department of Internal Medicine Division Of Rheumatology, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Peter J Kneuertz
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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Bridges JF, la Cruz MD, Pavilack M, Flood E, Janssen EM, Chehab N, Fernandes AW. Patient preferences for attributes of tyrosine kinase inhibitor treatments for EGFR mutation-positive non-small-cell lung cancer. Future Oncol 2019; 15:3895-3907. [PMID: 31621403 DOI: 10.2217/fon-2019-0396] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: EGFR-tyrosine kinase inhibitors (TKIs) vary in efficacy, side effects (SEs) and dosing regimen. We explored EGFR-TKI treatment attribute preferences in EGFR mutation-positive metastatic non-small-cell lung cancer. Materials & methods: Patients completed a survey utilizing preference elicitation methods: direct elicitation of four EGFR-TKI profiles describing progression-free survival (PFS), severe SE risk, administration; discrete choice experiment involving 12 choice tasks. Results: 90 participated. The preferred profile (selected 89% of times) had the longest PFS (18 months) and the lowest severe SE risk (5%). Patients would need compensation with ≥three-times longer PFS for severe SEs. Patients would accept ≤7 months PFS reduction for oral treatments versus intravenous. Conclusion: Patients preferred longer PFS but were willing to accept reduced PFS for more favorable SEs and dosing convenience.
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Affiliation(s)
- John Fp Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | | | | | - Emuella Flood
- Patient Centered Outcomes, ICON, Gaithersburg, MD 20807, USA.,AstraZeneca, Gaithersburg, MD 20807, USA
| | - Ellen M Janssen
- Patient Centered Outcomes, ICON, Gaithersburg, MD 20807, USA
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Donnan JR, Johnston K, Chibrikov E, Marra CA, Aubrey-Bassler K, Najafzadeh M, Nguyen H, Gamble JM. Capturing Adult Patient Preferences Toward Benefits and Risks of Second-Line Antihyperglycemic Medications Used in Type 2 Diabetes: A Discrete Choice Experiment. Can J Diabetes 2019; 44:6-13. [PMID: 31311729 DOI: 10.1016/j.jcjd.2019.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/21/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To estimate the strength of preferences, relative importance and trade-offs that patients with type 2 diabetes make between characteristics of antihyperglycemic medications. METHODS We conducted a discrete choice experiment with a sample of Canadians with type 2 diabetes. Respondents completed 14 choice tasks and choose between 2 hypothetical drug alternatives, described by 8 characteristics (cost, efficacy, life expectancy, risk of macrovascular event, risk of microvascular event, risk of severe hypoglycemia, risk of minor side effects and risk of rare but serious side effects). An opt-out option was also provided. Characteristics used to describe the 2 drugs were identified using a literature review, focus groups and interviews. A multinomial mixed logit model was used to estimate choice probabilities. Willingness to pay (WTP) was used to assess trade-offs between characteristics. RESULTS A total of 502 survey responses were included. The average age of participants was 59±12 years. Participants were 59% men, and 62% had diabetes for at least 6 years. All characteristics were found to significantly influence choice. On average, patients were willing to pay a monthly cost for their therapy of $134 to achieve 3 additional years of life; $49 and $36 for a 20% reduction in their risk of macrovascular and microvascular events, respectively; $34 for a 1% drop in glycated hemoglobin; $29 for a 50% less risk of severe hypoglycemia over 10 years; $29 for a 50% less risk of a minor side effect and $17 for a 50% less risk of a rare but serious side effect over 10 years. CONCLUSIONS All 8 characteristics were shown to significantly influence choice, with cost and life expectancy carrying the most weight and serious and minor side effects carrying the least weight.
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Affiliation(s)
- Jennifer R Donnan
- School of Pharmacy, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Karissa Johnston
- School of Pharmacy, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Eugene Chibrikov
- School of Pharmacy, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Carlo A Marra
- School of Pharmacy, Memorial University, St. John's, Newfoundland and Labrador, Canada; School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Kris Aubrey-Bassler
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Mehdi Najafzadeh
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States
| | - Hai Nguyen
- School of Pharmacy, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - John-Michael Gamble
- School of Pharmacy, Memorial University, St. John's, Newfoundland and Labrador, Canada; School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, Ontario, Canada.
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Marchesini G, Pasqualetti P, Anichini R, Caputo S, Memoli G, Ponzani P, Resi V, Rizzo M, Serviddio G, Zanette G. Patient preferences for treatment in type 2 diabetes: the Italian discrete-choice experiment analysis. Acta Diabetol 2019; 56:289-299. [PMID: 30306406 DOI: 10.1007/s00592-018-1236-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/26/2018] [Indexed: 12/18/2022]
Abstract
AIMS Several drug classes are now available to achieve a satisfactory metabolic control in patients with type 2 diabetes (T2DM), but patients' preferences may differ. METHODS In a discrete-choice experiment, we tested T2DM patients' preferences for recent antidiabetic drugs, in the event that their treatment might require intensification. The following attributes were considered: (a) route of administration; (b) type of delivery; (c) timing; (d) risk of adverse events; (e) effects on body weight. Twenty-two possible scenarios were built, transferred into 192 paired choices and proposed to 491 cases naïve to injectable treatments and 171 treated by GLP-1 receptor agonists (GLP-1RAs). Analyses were performed by descriptive statistics and random effects logit regression model. RESULTS Preferences according to dosing frequency, risk of nausea and urinary tract infections (UTls) were similar across groups, age, sex and BMI. Administration route and delivery type accounted for 1/3 of relative importance; the risk of UTIs, nausea and dosing frequency for ≈ 20% each, and weight loss for only 6%. Two significant interactions emerged (p < 0.01): type of delivery × group, and weight change × BMI class. Irrespective of previous treatment, the three preferred choices were injectable, coupled with weekly dosing and a ready-to-use device (first two choices). In a regression model, being naïve or non-naïve changed the ranking of preferences (p < 0.001), and the order was systematically shifted towards injectable medications in non-naïve subjects. CONCLUSION Easy-to-deliver, injectable treatment is preferred in T2DM, independently of treatment history, and previous experience with GLP-1RAs strengthens patients' willingness to accept injectable drugs.
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Affiliation(s)
- Giulio Marchesini
- SSD Malattie del Metabolismo e Dietetica Clinica, Università "Alma Mater", Bologna, Italy.
- Department of Medical & Surgical Sciences, "Alma Mater" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Patrizio Pasqualetti
- Fondazione Fatebenefratelli per la Ricerca e la Formazione Sanitaria e Sociale, Rome, Italy
| | - Roberto Anichini
- Sezione Autonoma di Diabetologia e Malattie Metaboliche, Presidio Ospedaliero di Pistoia, Pistoia, Italy
| | - Salvatore Caputo
- Servizio di Diabetologia, Policlinico Gemelli, Università Cattolica, Rome, Italy
| | - Giuseppe Memoli
- Centro di Diabetologia "San Luca", Ariano Irpino (AV), Italy
| | - Paola Ponzani
- UO di Diabetologia, Ospedale La Colletta, Arenzano (GE), Italy
| | - Veronica Resi
- Servizio di Diabetologia, UO Endocrinologia e Malattie Metaboliche, Fondazione IRCCS Ca' Granda-Ospedale Maggiore, Policlinico, Milan, Italy
| | - Manfredi Rizzo
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Gaetano Serviddio
- Dipartimento di Scienze Mediche e Chirurgiche, Centro Universitario per la Ricerca e la Cura delle Epatopatie (CURE), Foggia, Italy
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Laba TL, Reddel HK, Zwar NJ, Marks GB, Roughead E, Flynn A, Goldman M, Heaney A, Lembke K, Jan S. Does a Patient-Directed Financial Incentive Affect Patient Choices About Controller Medicines for Asthma? A Discrete Choice Experiment and Financial Impact Analysis. PHARMACOECONOMICS 2019; 37:227-238. [PMID: 30367400 DOI: 10.1007/s40273-018-0731-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND In Australia, many patients who are initiated on asthma controller inhalers receive combination inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA) despite having asthma of sufficiently low severity that ICS-alone would be equally effective and less costly for the government. METHODS We conducted a discrete choice experiment (DCE) in a nationally representative sample of adults (n = 792) and parents of children (n = 609) with asthma. Mixed multinomial models were estimated and calibrated to reflect the estimated market shares of ICS-alone, ICS/LABA and no controller. We then simulated the impact of varying patient co-payment on demand and the financial impact on government pharmaceutical expenditure. RESULTS Preference for inhaler decreased with increasing costs to the patient or government, increasing chance of a repeat visit to the doctor, and if fewer symptoms were present. Adults preferred high-strength controllers, but parents preferred low-strength inhalers for children (general beneficiaries only). The DCE predicted a higher proportion choosing controller treatment (89%) compared to current levels (57%) at the current co-payment level, with proportionately higher uptake of ICS-alone and a lower average cost per patient [32.73 Australian dollars (AU$) c.f. AU$38.54]. Reducing the co-payment on ICS-alone by 50% would increase its market share to 50%, whilst completely removing the co-payment would only have a small marginal impact on market share, but increased average cost of treatment to the government to AU$41.04 per person. CONCLUSIONS Patient-directed financial incentives are unlikely to encourage much switching of medicines, and current levels of under-treatment are not explained by patient preferences. Interventions directed at prescribers are more likely to promote better use of asthma medicines.
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Affiliation(s)
- Tracey-Lea Laba
- Menzies Centre for Health Policy, Sydney Medical School, School of Public Health, The University of Sydney, Sydney, Australia.
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Nicholas J Zwar
- School of Public Health and Community Medicine, University of New South Wales, Randwick, Sydney, Australia
- School of Medicine, University of Wollongong, Wollongong, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Elizabeth Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Anthony Flynn
- Asthma Foundation Queensland and New South Wales, now part of Asthma Australia Limited, Sydney, Australia
| | - Michele Goldman
- Asthma Foundation Queensland and New South Wales, now part of Asthma Australia Limited, Sydney, Australia
| | | | | | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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41
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Reaney M, Bush E, New M, Paty J, Roborel de Climens A, Skovlund SE, Nelsen L, Flood E, Gater A. The Potential Role of Individual-Level Benefit-Risk Assessment in Treatment Decision Making: A DIA Study Endpoints Community Workstream. Ther Innov Regul Sci 2018; 53:630-638. [PMID: 30348019 DOI: 10.1177/2168479018807448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Benefit-risk assessment is the cornerstone of decision making in medical care, playing a critical role in bringing treatments to market by informing decisions regarding drug development, licensing and reimbursement, and informing treatment decisions made by health care professionals and patients in clinical practice. In regulatory approval decision making, benefit and risk attributes are identified and defined based on available, aggregated clinical data from registration trials. In the context of major developments in recent years for involvement of patients as partners in all phases of drug development and in health care improvement, decision makers increasingly recognize the importance of informing treatment decisions by patient needs, values, experiences, and preferences. Using this as a basis, a DIA workstream was convened to explore the potential of individual-level benefit-risk assessment as a supplement to traditional group-level benefit-risk assessment for evaluating treatment. Various approaches as to how this information could be collected, including via patient-reported outcome measures, open-ended questioning, and stated-preference methods are presented. The utility of this information for various stakeholders is discussed.
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Affiliation(s)
- Matthew Reaney
- 1 Sanofi, Guildford, United Kingdom.,2 University of Chichester, Chichester, United Kingdom
| | | | - Mary New
- 4 IQVIA, Reading, United Kingdom
| | | | | | - Soren E Skovlund
- 7 Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark.,8 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Adam Gater
- 11 Adelphi Values, Macclesfield, United Kingdom
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42
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Tervonen T, Schmidt-Ott T, Marsh K, Bridges JFP, Quaife M, Janssen E. Assessing Rationality in Discrete Choice Experiments in Health: An Investigation into the Use of Dominance Tests. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1192-1197. [PMID: 30314620 DOI: 10.1016/j.jval.2018.04.1822] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/19/2018] [Accepted: 04/11/2018] [Indexed: 05/28/2023]
Abstract
BACKGROUND Dominance tests are often applied to test for the rationality in the choice behavior of participants in discrete choice experiments (DCEs). OBJECTIVES To examine how dominance tests have been implemented in recent DCE applications in health and discuss their theoretical and empirical interpretation. METHODS Health-related DCEs published in 2015 were reviewed for the inclusion of tests on choice behavior. For studies that implemented a dominance test, information on application and interpretation of the test was extracted. Authors were contacted for test choice sets and observed proportions of subjects who chose the dominated option. Coefficients corresponding to the choice set were extracted to estimate the expected probability of choosing the dominated option with a logistic model and compared with the observed proportion. The theoretical range of expected probabilities of possible dominance tests was calculated. RESULTS Of 112 health-related DCEs, 49% included at least one test for choice behavior; 28 studies (25%) included a dominance test. The proportion of subjects in each study who chose the dominated option ranged from 0% to 21%. In 46% of the studies, the dominance test led to the exclusion of participants. In the 15 choice sets that were analyzed, 2 had larger proportions of participants choosing the dominated option than expected (P < 0.05). CONCLUSIONS Although dominance tests are frequently applied in DCEs, there is no consensus on how to account for them in data analysis and interpretation. Comparison of expected and observed proportions of participants failing the test might be indicative of DCE quality.
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Affiliation(s)
| | - Tabea Schmidt-Ott
- Evidera, London, UK; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - John F P Bridges
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew Quaife
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ellen Janssen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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43
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How Do Members of the Duchenne and Becker Muscular Dystrophy Community Perceive a Discrete-Choice Experiment Incorporating Uncertain Treatment Benefit? An Application of Research as an Event. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 12:247-257. [DOI: 10.1007/s40271-018-0330-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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44
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Janssen EM, Benz HL, Tsai JH, Bridges JFP. Identifying and prioritizing concerns associated with prosthetic devices for use in a benefit-risk assessment: a mixed-methods approach. Expert Rev Med Devices 2018; 15:385-398. [DOI: 10.1080/17434440.2018.1470505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Ellen M Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center of Excellence in Regulatory Science and Innovation, Baltimore, MD, USA
| | - Heather L Benz
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Jui-Hua Tsai
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John FP Bridges
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center of Excellence in Regulatory Science and Innovation, Baltimore, MD, USA
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45
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Janssen EM, Marshall DA, Hauber AB, Bridges JFP. Improving the quality of discrete-choice experiments in health: how can we assess validity and reliability? Expert Rev Pharmacoecon Outcomes Res 2017; 17:531-542. [DOI: 10.1080/14737167.2017.1389648] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ellen M. Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deborah A. Marshall
- Department of Community Health Sciences, University of Calgary, Health Research Innovation Centre (HRIC), Calgary, AB, Canada
| | | | - John F. P. Bridges
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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